{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T07:47:17Z","timestamp":1791791237923,"version":"4.3.4"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":284,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Canadian Respiratory Journal"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Silicosis is a preventable occupational lung disease caused by inhalation of respirable crystalline silica. Although traditionally associated with mining, it is increasingly recognized among workers who fabricate engineered stone, also referred to as artificial stone, for kitchen and other countertops. In Canada, updated surveillance data are limited, and no published case series have characterized engineered stone\u2013associated silicosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report a retrospective case series of 20 patients diagnosed with silicosis following occupational exposure to engineered stone in Ontario, Canada, between November 2015 and September 2025. Demographic, occupational, clinical, radiologic, and functional data were extracted from medical records. Continuous variables are reported as median and interquartile range (IQR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age at diagnosis was 52\u2009years (IQR: 41.5\u201364.5), and all patients were male, predominantly immigrants from Southeast Asia. Median occupational exposure to silica was 19\u2009years (IQR: 10.5\u201327.5). Although 80% reported respirator use, adherence was inconsistent, and workplace controls were often inadequate. Cough and dyspnea were the most common presenting symptoms (60% each), with a median diagnostic delay of 13.5\u2009months. Imaging showed simple silicosis in 70% and progressive massive fibrosis in 30%. Pulmonary function tests demonstrated predominantly restrictive impairment with reduced diffusion capacity. Outcomes were significant, including 15% mortality, median age at death of 43\u2009years, chronic hypoxia in 35%, and lung transplant referral in 30%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Engineered stone\u2013associated silicosis in Ontario is characterized by prolonged silica exposure, inadequate workplace protections, delayed diagnosis, and severe disease at presentation. These findings underscore the urgent need for strengthened regulatory measures to protect engineered stone workers: more effective occupational silica exposure controls, systematic respiratory health surveillance of workers at risk, and earlier recognition and diagnosis of silicosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/carj\/9386297","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T07:06:50Z","timestamp":1791788810000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Silicosis Among Engineered Stone Workers in Ontario, Canada: A Case Series of 20 Patients"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3808-1937","authenticated-orcid":false,"given":"Abeer","family":"Abdelsayad","sequence":"first","affiliation":[{"name":"Department of Medicine Faculty of Medicine University of Toronto  Toronto Ontario Canada  utoronto.ca"},{"name":"Respiratory Division Toronto Western Hospital University Health Network, and St Michael\u2019s Hospital  Toronto Ontario Canada  uhn.ca"},{"name":"Health Leadership and Clinical Education Program University of British Columbia  Vancouver Canada  ubc.ca"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8942-0721","authenticated-orcid":false,"given":"Ambrose","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Medicine Faculty of Medicine University of Toronto  Toronto Ontario Canada  utoronto.ca"},{"name":"Respiratory Division Toronto Western Hospital University Health Network, and St Michael\u2019s Hospital  Toronto Ontario Canada  uhn.ca"},{"name":"Center for Research Expertise in Occupational Diseases St. Michael\u2019s Hospital  Toronto Ontario Canada  stmichaelshospital.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4746-5310","authenticated-orcid":false,"given":"Susan M.","family":"Tarlo","sequence":"additional","affiliation":[{"name":"Department of Medicine Faculty of Medicine University of Toronto  Toronto Ontario Canada  utoronto.ca"},{"name":"Respiratory Division Toronto Western Hospital University Health Network, and St Michael\u2019s Hospital  Toronto Ontario Canada  uhn.ca"},{"name":"Center for Research Expertise in Occupational Diseases St. Michael\u2019s Hospital  Toronto Ontario Canada  stmichaelshospital.com"},{"name":"Gage Occupational and Environmental Health Unit Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada  utoronto.ca"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_10_1_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.3295"},{"key":"e_1_2_10_2_2","first-page":"117","article-title":"Silicosis Mortality Trends and New Exposures to Respirable Crystalline Silica\u2013United States, 2001\u20132010","volume":"64","author":"Bang K. M.","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/resp.14242"},{"key":"e_1_2_10_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16040568"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.23504"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1155\/2004\/857476"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2017-104428"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2023-108892"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/15459624.2019.1652757"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/00333549091244S112"},{"key":"e_1_2_10_11_2","volume-title":"Silica\u2013Occupational Health and Safety","author":"Canadian Centre for Occupational Health and Safety"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60235-9"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18137076"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2025.10.032"},{"key":"e_1_2_10_15_2","unstructured":"Australian Centre for Disease Control National Guidance for Doctors Assessing Workers Exposed to Respirable Crystalline Silica Dust 2026 https:\/\/www.cdc.gov.au\/resources\/publications\/national-guidance-doctors-assessing-workers-crystalline-silica-dust-practice-guide."},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/annalsats\/aaoag176"},{"key":"e_1_2_10_17_2","doi-asserted-by":"publisher","DOI":"10.5271\/sjweh.2247"},{"key":"e_1_2_10_18_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002152"},{"key":"e_1_2_10_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0033-8389(22)00859-4"},{"key":"e_1_2_10_20_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.7533-21"},{"key":"e_1_2_10_21_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2283020557"},{"key":"e_1_2_10_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/diseases13110372"},{"key":"e_1_2_10_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbres.2018.07.004"},{"key":"e_1_2_10_24_2","doi-asserted-by":"publisher","DOI":"10.5152\/TurkThoracJ.2021.19151"},{"key":"e_1_2_10_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajim.22687"},{"key":"e_1_2_10_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13460"},{"key":"e_1_2_10_27_2","article-title":"2025 TLVs and BEIs: Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices","author":"American Conference of Governmental Industrial Hygienists","year":"2025","journal-title":"ACGIH"},{"key":"e_1_2_10_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/27551938251314656"}],"container-title":["Canadian Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/carj\/9386297","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/carj\/9386297","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/carj\/9386297","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T07:06:52Z","timestamp":1791788812000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/carj\/9386297"}},"subtitle":[],"editor":[{"given":"Lipi","family":"Buch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/carj\/9386297"],"URL":"https:\/\/doi.org\/10.1155\/carj\/9386297","archive":["Portico"],"relation":{},"ISSN":["1198-2241","1916-7245"],"issn-type":[{"value":"1198-2241","type":"print"},{"value":"1916-7245","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-05-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"9386297"}}